How to become a doctor abroad: 5 questions to ask before you start

The illusion of a simple path and the questions we forget to ask

Several years ago, while I was still in high school, I started this website (kugno.ru) to figure out the world of medical education and what was available for students from Russia. I wrote to universities all over the globe, published their responses, and gathered information that was, first and foremost, for myself.

Over time, the site took on a life of its own, and I started getting emails from readers. Here are a few examples:

“Hi, I read your article… I’m a 2nd-year student at NSMU in Russia, and I was hoping to go straight into a residency program in Singapore after I graduate. Do you know any foreigners who graduated from Russia and had their diplomas recognized? Where can I get more information?”

“Hey Egor! I live in Vladivostok and just finished 9th grade… I’ve decided I want to go into medicine (surgery), but not in Russia—somewhere abroad. The original plan was the US, but given the current situation, I’ve started looking for backup options… We’re hoping for a scholarship, of course…”

“Hi Egor! My name is Kirill, I’m from Moscow and finishing up 11th grade. Thanks so much for your site; I’ve been reading it for a year. Here’s my situation: I did well on my state exams and I’m almost guaranteed a government-funded spot at Sechenov University. Everyone is telling me it’s the best option and I shouldn’t overthink it. But I can’t stop thinking about studying in Europe, maybe in the UK. So my main question is: should I drop everything now, give up the free spot in Moscow, and rush to prepare for applications abroad?”

These letters reveal a common and completely understandable mindset. Students see a beautiful picture of the Stanford campus or the Charité hospital and think, «That’s where I want to be!»

But they’re starting at the end. Choosing a university is not the first step in the massive quest that is «becoming a doctor abroad.» People pick a school without knowing anything about the country, the diploma recognition process, visas, or how they’ll support themselves for all those years.

I realized the first step isn’t choosing a university, but choosing a country (based on many criteria) and taking a hard, honest look at your own capabilities.

That’s why I decided to write this article—to guide you through the entire journey, from self-reflection and choosing a country to getting your license and the right to work. My goal is to share my perspective and help you avoid common illusions by building a realistic plan.

I’ve split this article into two parts to keep it from getting too long. In this first part, I’ll cover the foundation on which your decision should be built. But let me be clear: this isn’t a step-by-step roadmap. It’s a collection of foundational ideas.

The second part will explore two different strategies: going abroad for medical school right away, or finishing your medical degree in Russia first and then seeking recognition (nostrification) of your diploma.

I’m only focusing on a few countries here, chosen simply because there’s a vast amount of information about them online. Don’t get fixated on these specific examples—the principles I’m discussing apply to any country. Don’t worry, in future articles I’ll cover many other countries in more detail and write a dedicated post for each one worth your attention.

So, let’s begin.

Forget the photos of Stanford and Charité for a moment. Set aside the document checklists and salary comparison charts. Before you dive into the complex quest of becoming a doctor abroad, you need to take a step back and ask yourself some fundamental, uncomfortable, and brutally honest questions.

The decision to emigrate isn’t just a career change. It’s a complete reconstruction of your identity, career, and life. It’s a project where everything is on the line. And it must begin not with choosing a country or a university, but with deep self-analysis.

This article isn’t a «how-to» guide. It’s five key questions. Your answers will determine whether your plan is a bold, well-thought-out strategy or just an escape from reality into a world of illusion.

Question #1. Why do you really want to leave?

This is the first and most important question. Be radically honest with yourself. What is truly driving you?

«They pay more there» is the most common answer, but it’s also the most superficial. Yes, the financial aspect is important. In Russia, nearly 60% of doctors admit their salaries are too low to cover basic needs, and 80% have to work multiple jobs. Dissatisfaction with income and career prospects is a key motivator for moving.

But this isn’t a unique problem. It’s a global phenomenon known as «brain drain,» where specialists seek not only higher pay but also better working and living conditions. For example, doctors in New Zealand are leaving in droves for neighboring Australia, where the average salary is over 40% higher.

So, dig deeper. What’s behind the desire for more money?

Professional Dissatisfaction? Are you tired of systemic problems, a lack of resources, and limited opportunities for growth? Are you drawn to advanced technology, research, and a different culture of medical practice? Doctors who emigrate to Canada often cite not just economics but also the socio-political situation back home and the desire for a better quality of life for their families.
A Search for Safety and Stability? Are you looking for a more predictable social and political environment for yourself and your family?
A Fundamental Distrust in the System? Sometimes the reason lies deeper—in a lack of basic institutional trust in the healthcare system you work in.

Your answer here will shape your entire strategy. If your main goal is money, your path will look one way. If you’re searching for professional fulfillment or a different social environment, it will look completely different.

Understanding your true, deep-seated motivation is your compass. Without it, you risk arriving in a new country, facing the first set of challenges, and realizing the «golden mountains» were a mirage. The real source of your dissatisfaction will still be with you, because it was internal all along.

Question #2. What are you willing to sacrifice?

Emigration always comes at a cost. The price of a new life is high, and it’s paid in more than just money.

The obvious sacrifices: Friends, family, your social circle, your native language, and your cultural environment. Are you prepared for years of loneliness, for communicating with loved ones through a screen, and for your children growing up with a completely different cultural code?

The less obvious, but more critical sacrifices: Your values, your worldview, and even the climate. Moving isn’t just a change of scenery; it’s a change in the social contract and your physical surroundings.

Personal Safety and Firearms: Are you used to relying on the police, or do you believe the right to self-defense, including gun ownership, is a necessity? Your choice of country will be radically different. In the USA, gun ownership is a constitutional right. Meanwhile, the UK, Germany, Australia, Canada, and Japan have strict laws restricting access to firearms. In Japan, for instance, civilian handgun ownership is almost entirely banned.
The Role of Religion in Society: How important is religion to you? The USA is a country where faith and religious rhetoric play a significant role in public and political life. Most European countries, as well as Canada, Australia, and New Zealand, are far more secular, and religion is largely a private matter. Japan is one of the least religious countries in the world.
Climate and Lifestyle: Do you love snowy winters or prefer year-round warmth? This isn’t a minor detail; it’s a crucial factor in your daily comfort.
- Continental Climate: Toronto, Berlin, and New York will give you hot, humid summers and very cold, snowy winters.
- Temperate Oceanic Climate: London, Auckland, and Sydney have mild winters and comfortable, cooler summers.
- Subtropical Climate: Tokyo offers warm, but very humid and rainy summers, with cool but mostly clear winters.

You have to understand that you aren’t just moving to another country. You are accepting its rules, its values, and its weather. Are you ready for that?

Question #3. What is your realistic budget?

Every dream has a price tag. Before you go any further, you need to audit your finances. I’m not talking about money for a plane ticket and the first month’s rent. I’m talking about the capital required for a multi-year marathon.

Upfront Costs: This can be thousands, or even tens of thousands, of dollars. It includes exam fees, document legalization and translation, visa applications, and expensive prep courses. For example, for a foreign doctor, the standard pathway to a medical license in Australia can cost around AUD $13,000 before you even move.
Proof of Funds for a Visa: This is the biggest hurdle. Many countries require you to prove you have enough money to live on for a year.
- Germany: To get a visa for the purpose of professional recognition (§16d), you must have €1,091 per month for 2025 in a blocked bank account (Sperrkonto). That’s over €13,000 that needs to be sitting in an account before you even arrive.
- Canada: For an immigrant on the Federal Skilled Worker program, a single applicant needs to show proof of more than CAD $15,000.
- New Zealand: To get a temporary visa, you need to prove you have sufficient funds, such as at least NZD $1,000 per month for a visitor visa.
Cost of Living: Rent will devour the largest portion of your budget. A one-bedroom apartment in Berlin in 2025 will cost an average of €1,200–€1,400 per month. In Manchester, which is considered more affordable than London, it’s £700–£1,200. Meanwhile, in Tokyo, despite its expensive reputation, the cost of living (excluding rent) is lower than in many Western megacities, and salaries can be higher than elsewhere in Japan.

Create a detailed budget for 1-2 years. Factor in everything: rent, utilities, transport, insurance, and unexpected expenses.

Do you have this money? If not, what is your realistic plan to save it? Without an honest answer to this question, your plan is just a fantasy.

Question #4. Are you ready for total linguistic and cultural immersion?

Language proficiency isn’t just a box to check on a list of requirements. It’s the key to your professional competence and social integration. And this barrier is much higher than it appears.

Language as a Professional Tool:

English-Speaking Countries: To work in Australia or New Zealand, you’ll need to pass the IELTS exam with a score of at least 7.0 in every section. In Canada, the requirements might be slightly more relaxed if you graduated from a medical school where the language of instruction was English. Regardless, you need to master not just conversational English, but professional medical English, including slang and cultural nuances.
Non-English-Speaking Countries: Here, the challenge is an order of magnitude greater.
- In Germany, you don’t just need fluent German; you need specialized medical German at the C1 level, confirmed by the Fachsprachprüfung exam. This is a separate, multi-year project for a non-native speaker.
- In Japan, the barrier is even higher. You must not only be perfectly fluent in Japanese but also pass the national medical licensing exam, which is conducted exclusively in Japanese.

Cultural Integration: Are you ready to adopt a new work ethic? The German healthcare system, for example, is famously hierarchical. Are you prepared to face casual racism or prejudice? Even in a high-demand profession like medicine, immigrant doctors may encounter elderly patients who demand a «real» (i.e., local) doctor.

Integration is not tourism. It is a process that will force you to rebuild not only your speech but also your behavioral patterns, habits, and maybe even a part of your identity.

Question #5. What does «work-life balance» mean to you?

This question defines what your life will be like outside the hospital walls. Different countries offer vastly different philosophies on work, and the price of a high salary can be incredibly steep.

The USA and Japan: A Survival Marathon. American residency is notorious for its grueling hours. Despite reforms, residents are still capped at 80 hours per week. The situation in Japan is similar, with an 80-hour weekly limit for residents, though about 15% work even more. This is a colossal workload that inevitably takes a toll on physical and mental health. The physician burnout rate in the USA is among the highest, hitting 43% in 2024, while 38% of emergency doctors in Japan report burnout.
Europe: Protected Time. The UK and Germany have laws based on the European Working Time Directive, which mandates that the average work week for doctors should not exceed 48 hours. There are strict rules on shift lengths and mandatory rest periods. This is reflected in their burnout rates: Germany has one of the lowest at just 12%, and the UK’s is 22%.
Canada, Australia, New Zealand: A Mixed Model. The situation here is somewhere in the middle. In Canada, there is no single national standard, and a resident’s work week can reach 65-80 hours. In Australia, the standard work week is around 38 hours, but in practice, especially in surgical specialties, interns can work 60-65 hours per week. New Zealand offers a more manageable schedule of 40-65 hours per week for junior doctors. Burnout rates in these countries are also high: 35% in Canada (Ontario), up to 84% in Australia (across all healthcare workers), and 23% in New Zealand.

What matters more to you? The highest possible income, paired with the risk of complete exhaustion? Or a more moderate salary with guaranteed time for your life, family, and well-being? This choice will define not only your career but also your health and happiness for years to come.

Conclusion: from a dream to a strategy

If you’ve honestly answered these five questions and your enthusiasm hasn’t faded, you are ready to move from dreaming to strategizing. These questions aren’t meant to discourage you. Their purpose is to force you to think, analyze, and make decisions with your eyes wide open.

The path of an immigrant doctor is not a sprint; it’s a cross-country marathon. The only ones who finish successfully are those who have soberly assessed their strengths, understood their true motives, calculated the costs, and consciously chosen not only a country but also the version of themselves they are prepared to become.

Егор Кугно